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ANATOMY MUSCLES OF THE ARM AND THE SHOULDER Sa2023Amir.One of the most quoted verses of the Qur'an. When you think you're being held back, restricted, limited or 'falling behind', consider how you may actually have been gifted with an opportunity to reflect, to restore, to rethink and to discover important understandings and realizations about life, about love, about faith, and about hope. Alhamdullilah.Intended learning outcomes ﻢ ﺣﺮﻟٱ ﻦﻤﺣﺮﻟٱٱ مﺳﺑ • (BI-SMI LLĀHI R-RAḤMĀNI R-RAḤĪMI) IN THE NAME OF ALLAH THE MOST COMPASSIONATE THE MOST MERCIFUL. - identify the muscles of the shoulder and state their attachment sites, action and innervation - Identify the muscles of the arm and state their attachment sites, action and innervation IDENTIFY THE MUSCLES OF THE SHOULDER AND STATE THEIR ATTACHMENT SITES, ACTION AND INNERVATIONClavicleScapulaScapulaArticulation of Humerus With Radius and Ulna - and Ulna later!!!the Radius identify the muscles of the shoulder and state their attachment sites, action and innervation This is split into 3 groups: (axioappendicular covered in breast and axilla) - Scapulohumeral - Anterior axioappendicular muscles: - Pec major and minor - Deltoid - Teres major - Subclavius - Serratus anterior Rotator cuffs: - Teres minor - Posterior axioappendicular - Trapezius - Supraspinous - Latissimus dorsi - Infraspinous - Subscapularis - Levator scapula - Rhoboid major and minor Key terms: Intrinsic – originate from the scapula and/or clavicle,and attach to the humerus.rusDeltoid Deltoid – means triangle. Which is its shape and is why its divided into 3 sections. ORIGIN: lateral third of the clavicle, acromion and spine of scapula INSERT: deltoid tuberosity of humerus ACTIONS on the shoulder – Anterior fibres: flexion and medial rotation – Posterior fibres: extension and lateral rotation – Middle fibres: Major abductor of arm (takes over supraspinatus – from 15deg ) INNERVATION – Axillary nerveTeres Major Forms the inferior border of the quadrangular space. The relevance of this gap is that the axillary nerve and posterior humeral circumflex artery of the humerus pass through this space. ORIGIN: Inferior angle of the scapula (posteriroly) INSERTION: medial lip of the intertubecular groove of humerus ACTIONS: Adducts and extends shoulder Medially rotates arm INNERVATION: Lower subscapular nerve (because of the nature of where it inserts)ROTATOR CUFF MUSCLES (SITS)SUPRASPINATUS The rotator cuff muscles work to stabalise the shoulder joint. These 4 muscles originate from the scapula and attach to the humeral head. They work to pull the humeral head into the glenoid fossa. Glenohumeral joint = v stable. Supra = superior Spinatus = spine (of scapula) ORIGIN: supraspinous fossa INSERT: greater tubercle of the humerus ACTION: abducts arm 0-15deg, partially assists deltoid for 15-90deg. INNERVATION: suprascapular nerveINFRASPINATUS Infra = inferior Spinatus = spine (of scapula) ORIGIN: infraspinatus fossa INSERT: greater tubercle of humerus ACTION: laterally rotates arm INNERVATION: suprascapular nerveTERES MINOR ORIGIN: lateral border of scapula (posterior surface) INSERT: greater tubercle of humerus ACTION: Laterally rotates arm INNERVATION: Axillary nerveSUBSCAPULARIS Sub = beneath Scapuaris = scapula ORIGIN: Subscapuar fossa INSERT: lesser tubercle of humerus (only rotator cuff to insert here) ACTION: medially rotates arm INNERVATION: upper and lower subscapular nerves (makes sense because it covers the whole scapula so recieves innervation from upper and lower subscapular nerve)The perfect shawarma (Al-zain)IDENTIFY THE MUSCLES OF THE ARM AND STATE THEIR ATTACHMENT SITES, ACTION AND INNERVATIONIntroduction Upper arm is composed of 4 muscles spanning from the shoulder joint to the elbow joint. Anterirorly – ALL INNERVATED BY MUSCULTANEOUS NERVE AND SUPPLIED BY BRACHIAL ARTERY - Biceps Brachii - Brachialis - Corabrachialis Posteriroly – Radial N and profunda brschii artery - TricepsBiceps Brachii Bicep = muscle with 2 heads Brachii = of the arm Origin– Longhead = supragLenoid tubercle ; Short head = coracoid process Insert – both insert into radial tuberosity Action – supination of the forearm. Flexes arm at the elbow Innervation– muscultaneous nerve (When doing reflex of biceps brachii = spinal cord segment C6) Extra info: then blends with deep fascia fo forearmssue – bicipital aponeurosis. This forms the roof of the cubital fossa. ItCORABRACHIALIS Cora = coracoid process Brachialis = muscle of the arm (that flexes elbow joint) ORIGIN – coracoid process INSERT – medial side of humeral shaft (level of deltoid tubercle) ACTION – Priamrily - flexion of the arm at the shoulder Secondarily - weak adduction INNERVATION – muscultaneous N (obviously)Triceps Brachii posterior compartment Tri = 3 ORIGIN Longhead= infraglenoidtubercle Medial head= humerus (inferiortoradial groove) Lateral head= humerus (superirotoradial groove) INSERT Muscle converge intoone toisnert intothe olecranon of the ulna ACTION – extension of the arm at the elbow INNERVATION – Radial N Reflex= spinal segment C7 (In some individuals long headof triceps brachii is innervatedby axillary nerve)CCA style questions Tip when starting CCA Qs: Orientate yourself first, no matter how obvious the answer is. For example if I am asked Locate the biceps brachii, its attachment and insertion. My thought process is as follows and I'd mention every thought out loud to the examiner: 1. I know this structure lies in anterior upper arm so I will look at the anterior arm 2. I also know it is a 2 headed muscle that fuse into one at the point of insertion (2 obvious points that help me imagine the muscle so I know exactly where its origin is and insertion) 3. the short head inserts at the coracoid process and the long head inserts at the supraglenoid tubercle 4. they fuse together to insert into the radial tuberosityCCA style questions 1. What is the origin of the short head of Biceps Brachii? 2. Name and locate a rotator cuff muscle. 3. Find the medial epicondyle of the right Humerus. 4. Identify the insertion of teres major. 5. Name 2 structures that goes through the quadrangualar spaceBrachiallis Brachii = muscle of the arm It forms the floor of the cubital fossa. ORIGIN – medial and lateral surfaces of humeral shaft INSERT – ulnar tuberosity ACTION – flexion at the elbow INNERVATION – Muscultaneous N Important to note also has contributions from radial N !Which muscles make up your quadrangular space and lower triangular space and what structures run through themWhere do the rotator cuffs insert into what is there function overall functionName one muscle in the anterior upper arm which has double innervation and name the nerves Biceps brachii Muscultaneous N Radial NExam style questionsExam style questions